Comparing Diabetes Support in 3 Countries
Clayton Velicer, MPH
In this week’s blog, we discuss the findings from a recent article that compares the peer-led MoPoTsyo program in Cambodia with diabetes support programs in two other low- and medium- income countries (DR Congo and Philippines).
The program in Kinshasa, DR Congo includes 80 primary care centers (called Kin-Reseau) that deliver diabetes care as part of its basic package. The program was founded 40 years ago by a missionary doctor that trained the health center staff to decentralize care. The centers offer a weekly health center visit and bi-monthly medical consultation by a trained doctor that includes glucose and blood pressure measurements and foot care. Medicines are offered at subsidized rates and patients on insulin receive their injections at the health center with a nurse’s assistance. An additional screening at the local hospital is advised but not included in the package.
The MoPoTsyo Patient Information Centre has developed a network of community-based peer educators. The program began in 2005 in Phnom Penh when two patients with diabetes received a short training and then searched within the community in hopes of establishing a peer group for exchanging diabetes-related information. Since that time, the program has expanded to 12 districts, more than 130 peer educators and 7000 patients. The peer educators spend an average of 90 minutes per week on their roles and receive a small financial incentive for their activities. The organization has implemented a system to support and monitor the peer educators and improve access to local medical services. The MoPoTsyo program includes peer education group sessions on a monthly basis, urine strips for self-monitoring, urine and blood testing twice a year and a consultation with a doctor in a local hospital. The peer-led sessions include diabetes education, physical measurements, routine prescriptions and feedback on self-monitoring. The participants pay small fees for each service. To learn many more details about the program, please check out our three-part blog series authored by the organization’s president in 2012.
The third program evaluated was the “First Line Diabetes Care Project” (FiLDCare) in the Philippines. As part of this program, founded in 2009 as a research project, patients receive primary care and self-management education in a health facility. The patients also receive support from a community health worker specially trained in diabetes self-management. The program runs at 3 locations, one urban and two rural areas, and there are approximately 1000 patients and CHW educators in the program. The CHW support is available on a daily basis with frequency of contact adapted to the patient’s need. The CHW support and consultations at the health facilities are free, but participants pay a small free for lab examinations and buy medicines in a private drug store at market prices.
Van Olmen notes that there are important differences between the populations in these programs and looks the different contextual factors that influence their success.
“Health outcomes of persons with diabetes are determined by their bio-psycho-social characteristics and by their behaviour, which are each subject to the content of care and the approach to chronic illness self-manage of the programme in which they participate”
Despite these limitations it was noted that the participants of MoPoTsyo had the strongest clinical improvements including HbA1C, blood pressure and foot lesions. All programs were viewed as having a positive impact with 80% of participants following their recommended diabetes care and more than two thirds walking at least 20 minutes each day.
However, MoPoTyso is an organization that mainly targets people with diabetes, and those with access to more external resources than participants in the other programs. As an overall observation, the authors note that active diabetes detection through community screening seems to lead to patients entering programs at younger ages and at earlier stage of disease which leads to improved outcomes. It is believed that evaluation of the programs in different communities and settings will help when establishing new programs in other contexts. While the full details of this evaluation are beyond the scope of our blog, we encourage our readers to read the full paper.